Sophia Griffioen, paediatric oncology nurse, Paediatric Oncology Centre of the Free University of Amsterdam

In the field of paediatric oncology, the nurse is continuously aware of falling short in preparing children for frightening examinations, painful shots and scary operations. No matter how well they try to minimise the fear and distress, the grief can never be eliminated. Therefore there is a continuous search to supplement and improve the existing methods of preparation. That is why the paediatric oncology division of the Academic Hospital of the Free University has decided to add a visual support to the current way of preparing children. This article is to provide information about our current method of working and its supplement.

In preparing children with scary or difficult procedures the nurse tries to take away the child's fear. This will not occur by keeping silent about it but rather to make it a subject of discussion. A child with cancer has to continuously endure all kinds of examinations. So it is of all the more importance to be clear and comprehensible about what the child is to expect. In our explanations we therefore use a photo book with the images of the machines with which the child will be confronted, like a MRI or an ultrasonograph.

In practice children usually listen to these explanations quietly and generally have few questions. This is quite understandable, because the child is confronted with matters of which he / she has never heard of let alone thought about. Both the content and the amount of information has a frightening effect on the child. And because we are faced with children of different age groups and backgrounds, we were convinced that one standard preparation is not sufficient. Knowing that children have a strong affinity for images, we decided to simulate the different situations in which children will end up and record them on video. 

In 1997 we started to think of situations that would lend themselves to this approach. First, we thought of bone marrow and lumbar punctures since these procedures take place literally behind the child's back. We enlarged our list to include: inserting a Port   à Cath, the care of a Broviac line, being measured for a radiation mask, inserting a feeding tube, undergoing a MRI examination, a CT scan and an abdominal ultrasound. Each video recording is introduced and concluded by a professional actress while children themselves play out the different situations. Each subject takes three to seven minutes and can be shown separately. By the end of 1997 we were ready to start with this way of informing.

The video has not taken the place of verbal preparation, but is clearly meant as a support thereof. Moreover, each child is free to choose whether or not to see the video recording. To evaluate if and to what extent this approach is fruitful, we have made a questionnaire in which we ask both parents and children if this method has helped reduce fear. By now it is obvious that many children desire to watch the video, but it is still too early to conclude if the method does what it intends to do.

Information:

Sophia Griffioen

AZVU, polikliniek Kinderoncologie

Postbus 7057, 1007 MB Amsterdam

The Netherlands

NB. The videos won the Crystal Serpent at the international medical film festival Filmobidos 1999 and the second prize at the EtmA festival, a British organisation for educational media (the editors).